Surgery

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Ambulatory cleft lip surgery in a developing country
(2015) Olawoye O.A; Olusanya A.A; Ademola S.A; Iyun A.O; Michael A.I; Akinmoladun V.I.
Background: Ambulatory cleft lip surgery has been practiced extensively in many developed countries, however cleft lip repair in most developing countries involve patient hospitalization of varying duration. Driven bythe recent acute shortage of pediatric bed space in our hospital, an increasing number of cleft lip surgeries are being performed on out-patient basis. The aim of this study was to report our experience with ambulatory cleft lip surgery at the University College Hospital, Ibadan. Methods: A retrospective review of Cleft lip Surgeries performed between February 2007 and January 2010 was done. Data of patients who had cleft lip surgery was retrieved from our Smile Train data base, the operating room surgery records and the Nurses' admission/discharge records on ail the wards on which the patients were either received or admitted. Information obtained included the demographic characteristics of the patients, complications reported, length of stay (LOS) for in-patients and the need for re-admission before the first follow-up clinic appointment among the two groups. Results: Eighty three patients were identified but complete data was obtained for forty patients. (Retrieval rate of 48%) The ambulatory group comprised of 15 patients while- the in-patient group had 25 patients. The mean patient age was 5.7years in the ambulatory and 9.7 years in the in-patient group. Both groups were homogenous for other parameters. None of the patients in the ambulatory group was re-admitted for any post-operative complication while only one patient in the in-patient group had a post-operative complication necessitating prolonged hospitalization. Conclusion: Ambulatory cleft lip surgery was found to be safe in our practice with comparable patient outcome to the in-patient group. It is anticipated that this may assume increasing prominence in the scope of cleft lip management in many more centers in the developing world.
An analysis of skin cancer in albinos in ibadan
(2015) Ademola S.A.
Context: Skin cancers are common among albinos living in Africa. Deleterious effect of ultraviolet rays from sunlight and nearness to the equator places the African Albinos at risk for skin cancer. Aims: This study aims to present skin cancers in albinos as seen by a plastic surgeon, sensitize the public to the magnitude of dangers that albinos are exposed to, highlight the challenges faced in their management and suggest strategies for improved outcomes. Settings and Design: A retrospective review of skin cancers among albinos was conducted at the University College Hospital, Ibadan, Nigeria. Methods and Material: The charts, operation and cancer registry records of all albinos referred to a plastic surgery division over a ten year period was reviewed. Demographic data and relevant information relating to skin lesions were extracted. Statistical Analysis: Descriptive analysis was done with the aid of statistical package for social sciences (SPSS) version 20. Results: Nineteen patients with fifty nine skin lesions comprising 13 males and 6 females were reviewed. Mean age of the patients was 33.6 (SD 12.8) years, 50% were unmarried, over 90% were Christians and 44% were not employed. The lesions were on the face in 84.6% while scalp and neck lesions were present in 36.8 and 31.6% of patients respectively. In 73.7% of the patients, the lesions were advanced. Basal cell carcinoma and squamous cell carcinoma were of equal proportion. Conclusions: Albinos in Nigeria should be exposed to public health intervention to reduce the incidence of skin cancers through targeted public health educational programmes; structured multicenter and population based research, surveillance, and improved access to healthcare.
Awareness and attitude of doctors and nurses at a crossmark teaching hospital to skin donation and banking
(2014) Michael A.I; Ademola S.A; Olawoye O.A; Iyun A.O; Oluwatosin O.M.
Introduction: This study sought to determine the awareness and attitude of doctors and nurses in a teaching hospital to skin donation and banking, and to identify needs for personnel educational programmes. Methods: A cross sectional survey on doctors and nurses was carried out using a 44-item questionnaire that included a Likert scale on attitudes. Predictors of favourable attitudes were determined. Results: Eighty (49.7%) doctors and 81 (50.3%) nurses participated in the study. Many participants, 126 (78.3%), knew that skin could be donated, but only 96 (59.6%) participants were aware of skin banking. The main source of information was during professional training (17.4%). Only 41 (25.5%) participants were willing to donate skin after death. Body disfigurement was the major reason (20.5%) against skin donation. Participants who were doctors, were aware of skin banking, and who were previous blood donors had higher attitudes scores (p < 0.001, p = 0.004, p = 0.007 respectively). Being a doctor and having heard of skin banking were predictors of favourable attitudes to skin donation and banking. Conclusion: Knowledge transfer during health professional training on the usefulness of banked skin in patients with major burns may lead to improved attitude of health professionals and acceptance of this modality of burn management.
Changing epidemiology of skin cancers in southwestern Nigeria.
(2006) Ademola S.A; Gana J.; Oluwatosin O; Ogundoyin O.
Introduction: The incidence of some skin cancers is on the rise in Caucasians1. There is also an observed increase in the diagnosis of Basal Cell Carcinoma in blacks. This study evaluated the Pattern of Skin Cancers in Southwestern Nigeria and compared the trends with what obtained three decades earlier. Methods: A review of 494 cases of skin malignancies recorded at the National cancer registry, Ibadan, Nigeria between January 1981 and December 2000 was carried out. The proportion observed was compared with a similar study carried out thirty years earlier. Results: The commonest lesion recorded was squamous cell carcinoma 40.5%. Malignant Melanoma was 25.1%, Dermatofibrosarcoma Protuberance 9.5%, Kaposi’s Sarcoma 8.3% and Basal Cell Carcinoma 6.7%. There was an observed decline in the proportion of Squamous Cell Carcinoma and an increase in the proportion of Basal Cell Carcinoma. Conclusion: There is a change in the incidence of skin cancers in Southwestern Nigeria.
Clefts of primary and secondary palate: a review of history and of cases seen from 2001 to 2005
(2006) Adekolujo; Dr lyun; Ademola S.A; Oluwatosin O.M.
The management of the cleft of the primary and secondary palate is interdisciplinary. It is complex endeavor requiring coordinated expertise of several specialists in various disciplines. We reviewed 62 patients with cleft of the primary and or the secondary palate managed between January 2001 and September 2005. The mean age at presentation was 25 months. There were 34 females (54.8%) and 28 males (45.2%). Isolated cleft of the primary palate was the most frequent accounting for 44.3%, of the patients while cleft of the primary and secondary palate was seen in 41.0%, and isolated cleft of the secondary pedate in 13.1 %. The male to female ratio in patients with isolated cleft of the primary palate (unilateral and bilateral) was 1.1 to 1, for unilateral cleft of the of the primary palate was 1.56 to 1 but all the patients with isolated bilateral cleft of the primary palate were females. The male to female ratio for patients with cleft of the primary and secondary pedate was 1 to 1 but all the patients with isolated cleft of the secondary palate were females. In cleft of the primary palate, the cleft was most frequently on the left and was complete in 63.8%. Associated malformations were seen in 11.3% of the patients, the most common being cardiac malformations We conclude that there is a need for a formation of a formal cleft team in our center to facilitate the optimum management of these patients.
Comparative review of burns with inhalation injury in a tertiary hospital in a developing country
(2016) Iyun A.O.; Ademola S.A.; Olawoye, O.; Michael A.I.; Oluwatosin O.M.
Objective. Inhalation injury is an acute respiratory tract insult caused by direct thermal injury, carbon monoxide poisoning, or toxic chemical inhalants, such as fumes, gases, and mist. The aim of this study is to review the authors’ experiences in a regional burn unit in a developing country. Methods. The university college Hospital, Ibadan, Nigeria prospective burn unit database was retrospectively reviewed from January 2001to December 2013and analyzed using SPSS software, version 16 (SPSS Inc, Chicago, IL). Results. There were 840 patients in all, 63% (527) had cutaneous burns only, while 37%(313) had associated inhalation injury. There was a male preponderance in both groups. Those with cutaneous burns only and those with associated inhalation injury had a male to female ratio of 1.6;1 and 1.5:1, respectively. The mean ages were ears (inhalation injury) and 21 years ± 17 years cutaneous burn only) (P < 0.05). The mean total body surface area (TBSA) of the burn injuries was 55% (inhalation injury) and 25% cutaneous burn only) (P < 0.05). Burn injury occurred most frequently between 19.00 hours and 24.00 hours, and 56% of burn es that occurred during this time were associated with inhalation injury (P < 0.05). Major causes of burns were flames and scalding (86.2%). Mortality was 71% in patients with inhalation and 26% in patients with cutaneous burns only (P < 0.05). Conclusion. The association of inhalation injury with cutaneous burns portends a grave condition. An upgrade of expertise and infrastructure in the management of these patients is necessary in order to improve outcomes.
Demographic characteristics and prognostic indicators of childhood burn in a developing country
(2014) Olawoye O.A; Iyun A.O; Ademola S.A; Michael A.I; Oluwatosin O.M.
Children constitute a significant proportion of burn victims in most studies from the developing countries. While there has been a progressive improvement in the outcome from childhood burn in many developed nations, the morbidity and mortality remains high in many low and middle income countries. The aim of our study is to evaluate the demographic characteristics and prognostic indicators of childhood burn in a major referral teaching hospital in a developing country. A review of the records of 638 patients with acute burns managed over a 10-year period from January 2001 to December 2010 at the University College Hospital, Ibadan Nigeria was done. The clinical and epidemiological data were retrieved from computerized data base using the ISBI proforma. Information obtained includes Biodata, Etiology, location, TBSA, presence of Inhalation injury and the treatment outcome. Data of patients aged 16 years and below were analyzed using the SPSS version 16. The main outcome measure was the patient’s survival. 289 children representing 45.3% of the total number of burn patients were managed over the period. The M:F ratio was 1.1:1. The median age of the cohort was 4.0 years while the median TBSA was 21.0%. Nonintentional causes were responsible for 89.6% cases. Most of the injuries (88.6%) occurred at home. Eighty-three patients had inhalation injury out of which 57 (68.7%) deaths were recorded. The overall mortality rate in the cohort was 39.5% with an LA50 of burn size of 45%. The TBSA was also found to be a determinant of outcome. Majority of childhood burns are from preventable causes with attendant dismal mortality figures. Effective burn prevention strategies and improved quality of care remain pivotal in reducing childhood burn morbidity and mortality in the developing countries.
Diabetes and surgery
(2007) Ademola S.A
Distribution and morphological pattern of clefts in the craniofacial region seen in a sub-saharan tertiary hospital
(2015) Olusanya A.A; Michael A.I; Olawoye O.A; Akinmoladun V.I; Ademola S.A; Iyun A.O; Oluwatosin O.M.
Aim: Clefts in the craniofacial region are one of the commonest congenital anomalies recorded in literature. The incidence varies globally with racial differences observed. In Nigeria, the evaluation of the absolute incidence of oral clefts is a challenge as births and deaths are not adequately registered. Especially lacking is the relative prevalence of rare craniofacial clefts to the more common cleft lip and palate anomaly. This study aims to document the pattern of distribution of craniofacial clefts, including cleft lip and palate anomaly, rare craniofacial clefts, unusual presentation of some of these anomalies, as well as other abnormalities noted in affected cleft patients seen at our centre. Material and methods: Information on age, gender, weight at presentation, type of cleft anomaly, other abnormalities, as well as affected relatives were extracted from the clinic records of the Cleft Clinic of the University College Hospital, Ibadan, Oyo, Nigeria, from April 2010 to September 2012. Results: One hundred and forty-two cases were seen within the 30-month period, consisting of 58 men and 84 women with a mean age of 43.54 months and a median of 2.0 months. Eighty-eight per cent of the cases were cleft lip and palate anomalies, while 12.0% were craniofacial clefts. Thirteen per cent had other abnormalities, while 3.5% were considered to be unusual cleft anomalies. Conclusion: The pattern of distribution of clefts in the craniofacial region in our centre has been documented. Cleft of the primary palate was the commonest while rare craniofacial clefts constituted about one-eighth of all the craniofacial clefts.
Does topical application of bupivacaine (Marcaine)to skin graft donor site have any effect on moriarty sign?
(2000) Oluwatosin O. M; Abikoye F. O; Ademola S. A; Sanusi A. A; Soyannwo O. A.
Moriarty sign designates that when split skin donor site is more painful than recipient site,good graft take is likely. This prospective study was designed for the dual purpose of confirming the validity of Moriarty sign and to determine if bupivacaine topical anaesthetic application to split skin donor site will influence the sign. The difference in response to pain indicated by Moriarty sign between patients that had topical analgesic treatment and those that did not was statistically significant from day one to day five post operatively. Routine application of long acting topical analgesic to donor site is advocated ( Nig J Surg Res 2000;2:131-134)
Focal palmoplantar keratoderma in 2 children leading to gait abnormalities.
(2006) Adebola. O.; Ademola S.A.
Hereditary focal palmoplantar keratoderma are a heterogeneous group of disorders of keratinization characterized by focal areas of thickening of the palms and soles Different genetic abnormalities have been identified for the disorders under this group. However most of them have palmoplantar keratoderma as a common manifestation. This report is about Nigerian children who presented with focal palmoplantar keratoderma without associated disorders. They presented with gait abnormalities resulting from the plantar hyperkeratosis. One of the children had surgical excision of the lesions with skin grafting, which greatly improved the gait abnormality. Perhaps surgical intervention should be carried out earlier in this group of children in case of absence of other treatment modalities available so as to prevent permanent gait abnormalities. have a similar problem. Examination revealed a young boy with normal scalp hair. His dentition and buccal mucosa were normal. His palms and nails were also found to be normal. The soles of the feet showed bilateral striate hyperkeratosis warty in appearance with well defined edges. Both ankle joints were hyper extended. All other systems were within normal limits. Histology of the excised tissue showed marked hyperkeratosis, acanthosis, hypergranulosis and acanthosis. Histologic features of epidermolytic hyperkeratosis and human papilloma virus were absent. A diagnosis of focal palmoplantar keratoderma without associated features was made, most likely of the striate type. In view of the extent of the lesions and the gait problems. Surgical excision of the hyperkeratosis was suggested. The areas with warty hyperkeratoses were excised bilaterally and skin was taken from the thighs and grafted to the feet. Both grafts healed well. He was then encouraged to bear weight gradually on the graft with the help of physiotherapy. The graft keratinized gradually in the pressure bearing areas and he was adviced to use well padded shoes and take extra care of his feet. He also started physiotherapy to encourage ambulation.
Goldenhar syndrome: a case report and literature review
(2005) Bekibele C.O || Ademola S.A || Amanor-Boadu S.D || Akang E.E.|| Ojemakinde K.O; Ademola S.A; Amanor-Boadu S.D; Akang E.E.; Ojemakinde K.O
Summary The case of a 24-year-old female Nigerian with features of Goldenhar syndrome is presented and the challenges of management especially with reference to reconstructive facial surgery and general anaesthesia are discussed.
Great saphenous vein stripping using nasogastric tub
(2012) Ademola S.A; Adekolujo O.S; lyun A.O; Yunusa-Kaltungo Z |; Nnadozie U.U; Michael A; Oluwatosin O.M.
Background; Crossectomy and Great Saphenous Vein (GSV) stripping remains the gold standard of treatment for great saphenous varicose vein. Many techniques of GSV stripping have been described. However, very few hospitals in developing countries are equipped with a vein stripper. Method and result: We describe the use of nasogastric tube in the stripping of GSV. This simple technique has been successfully applied in three patients. Conclusion: There is a need to carry out a prospective study regarding the application of this technique of GSV stripping.
Hypertensive patient in the surgical ward - what the Surgeon should do
(2004) Akute, O. 0; Olubowale, 0. 0|; Aghahowa, M. E; Afolabi., A. 0
Two cases of hypertension are presented to emphasize the need for the surgeons to pay adequate attention to these purely medical conditions that may have a devastating adverse effect on the outcome of surgery. The article also highlights the serious constraints that still characterize the management of these patients in this part of the world. The ideal situation is a multi-disciplinary approach involving the Surgeon, the Physician and the Anaesthetist. The surgeon must not confine himself to the technical aspect of the surgery alone. The hypertension must be controlled whether the patient presents with an elective or emergent surgical condition and anti-hypertensive medication must be continued up till the time ofsurgery and at times intra-operatively. It is not only unnecessary hut also potentially dangerous to withdraw anti-hypertensives before anaesthesia. The main goal of the surgically amenable secondary hypertension is to remove the cause ofter adequate control of the hypertension in preparation for surgery. Patient however must be made to understand that the hypertension may not be "cured" and the anti-hypertensive medication may have to be continued post-operatively particularly if the hypertension is long established before patient presents. Local and/or regional blocks are to be preferred to general anaesthesiafor peripheral lesions and even then it is still preferable to have the hypertension controlled.
Identification of ASAH1 as a susceptibility gene for familial keloids
(Macmillan Publishers, 2017) Santos-Cortez R.P.; Ying Hu; Fanyue Sun; Benahmed-Miniuk F.; Jian Tao; Kanaujiya J.K.; Ademola S.; Fadiora S.; Odesina V.; Nickerson D.A.; Bamshad M.J.; Olaitan P.B.; Oluwatosin O.M.; Leal S.M.; Reichenberger E.J.
Latex glove conduit as improvised blood vessel model for microvascular anastomosis training
(Elsevier Ltd, 2020) Aderibigbe, R.O.; Ademola, S.A.; Michael, L.A.; Olawoye, O.A.; Iyun, A.O.; Oluwatosin, O.M.
Background: In the growing need of microvascular surgery in modern-day plastic surgery, financial burden on surgeon or institution can discourage acquisition of skill particularly in the initial phase of laboratory simulation. This article describes the construction of a cheap, easy-to-make blood vessel model. Materials and method: The model was made using infusion giving set, latex glove, scissors, tape measure and Swan glue CD 308. A cut sheet from the latex glove was rolled twice over two glue- painted segment of the infusion giving set stent. The stents were gently pulled out, turning the sheet into a conduit. The blood vessel model was then allowed to dry. Discussion: The use of latex glove for initial training in microvascular anastomosis has been for long. Previously described productions into a conduit are cumbersome. This model is easy to construct and is useful in an office or dry laboratory setting. Conclusion: The latex glove blood vessel model described in this article is a useful material in the training of budding microsurgeons. Residents in our institution have reported a very good learning experience with its use.
Management of cleft lip and palate in Nigeria: a survey
(Wolters Kluwer, 2018) Akinmoladun, V.; Ademola, S.; Olusanya, A.
Background: Clefts of the lip and/or palate are the most common congenital craniofacial defects and second only to club foot among all congenital anomalies. The management of this condition is resource intensive due to the multidimensional needs. This survey was carried out to ascertain the current state of cleft management in Nigeria with emphasis on training, scope of management, and assessment of treatment outcome. Materials and Methods: Structured questionnaires were administered to cleft surgeons based on professional and practitioners’ register and the result of literature search for cleft surgeons whose names may not appear in the registers. Results: A total of 69 returned questionnaires were analyzed. The highest number of surgeons was from southwest geopolitical region while the northeast had the least. Fifty-eight (84.1%) were specialists with the fellowships. Forty-seven had been cleft surgeons for <10 years. Majority undertook lip repair between 3 and 4 months while 50% did cleft palate at or more than 9 months. Millard rotation and advancement was used for lip repair by 91.2% and 44 employed the von Langenbeck technique for palatal repair. Forty-six respondents carried out nasal repair at the time of lip surgery with 44 doing this as closed rhinoplasty. Adhesive tapes were usually employed by 44 (63.7%) for managing the protruding premaxilla. Orthodontic evaluation was not usually part of the treatment plan of 34 respondents. Otology assessment and assessment of velopharyngeal competence were rarely done. Revision surgeries, alveolar bone grafting, rhinoplasties, and maxillary osteotomies were uncommon. Interdisciplinary team care approach was practiced by 54 (78.2%) respondents. Conclusion: Findings suggest an increase in the number of surgeons, but the training, scope, and standard of care remain relatively limited. Audit and assessment of the practice should also become points of emphasis.
Management of haemorrhoid in a tropical .country
(2004) Agbakwuru E.Aug.; Adesunkanmi A.R.K; Ujba A.F; Fadiora S.O.; Ademola S.A; Ogunrombi A.B.
To appraise the pattern of presentation and management of Haemorrhoids in Ile-Ife. Setting: State Hospital and Wesley Hospital, Ilesa 2 major units of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria. Design: Retrospective Study. January 1990 to December, 2001 Patients and Method. 70 patients who presented with prolapsed (second and third degrees), over 11 years period were studied. Results Age Range was 10-80 years (average 27.8 + 1.9) with a male preponderance. Sixty-seven percent had prolapsing pile; 61.4% had open .excisional haemorrhoidectomy. Conclusion: It is felt that the late presentation was mainly due to fears, false belief and quackery often associated with the disease and its treatment. It was therefore suggested that more effort be made towards education of population in other to reduce above problems and encourage early presentation so that less invasive costly techniques could be used.
Management of hypospadias in a resource-poor setting: the Ibadan experience
(Wolters Kluwer, 2018) Ogundoyin, O.O.; Olulana, D.I.; Lawal, T.A.; Ademola, S.A.
Background: Penile anomalies especially hypospadias are one of the most common genitourinary anomalies seen in newborns, and they pose a great deal of psychological stress to their mothers. This study examined our experience in the management of hypospadias. Patients: and Methods A retrospective study of all patients (Group A) managed for hypospadias from 2004 to 2013 was conducted. Data obtained included patients’ demography, their clinical presentation and management. These were analysed and compared with a similar study (Group B) conducted in this hospital four decades earlier between 1966 and 1977. Results: Forty-eight patients belonging to Group A had repair of hypospadias in comparison to the 42 patients in Group B. The mean age at presentation in Group A was 2.7 ± 4 years, and the anomaly was discovered at birth in all the patients. In contrary, Group B had 32 (76.2%) patients who presented immediately after birth and 10 (23.8%) patients who were either adolescents or adults (12-36 years) with a mean age of 18.9 years. Anterior hypospadias occurred more commonly in both groups; 10 (20.8%) patients were circumcised in Group A and 4 (9.5%) patients in Group B. Surgical site infection was the most common post-operative complication observed in both groups. The type of surgical repair was observed to have significantly influenced the outcome of surgical repair in patients in Group A (j2 = 14.13, P = 0.05). Conclusion: Proper and successful management of hypospadias can be enhanced in this environment with adequate media advocacy directed at prompt recognition of this anomaly and avoidance of circumcision when hypospadias has been identified.
Management of lower extremity soft-tissue sarcoma in a sub-saharan african teaching hospital: case reports
(2019) Ayandipo, O.O.; Ademola, S.A.; Afuwape, O.O.; Michael, A.I.; Elemile, P.O.; Udonsak, N.S.
Background: Soft-tissue sarcomas are relatively rare tumors and can occur in many parts of the body. When they affect the body extremities, their management can be challenging, often leading to limb amputation. Recent advances in surgery, adjuvant therapy, and better collaboration among different surgical specialists, medical and radiation oncologists, coupled with management in specialized centers have led to an upsurge in limb preservation. However, this is not obtainable in many centers in the developing countries. We report cases of soft-tissue sarcoma of the lower limb in two patients managed in a tertiary center in sub-Saharan Africa and the challenges encountered in their management. Case Reports: Two patients presented to our hospital with progressive painless masses on the lower third of their legs. Evaluation suggested that the masses were malignant. They both had wide local excision. The first patient had reconstruction with island sural artery fasciocutaneous flap, whereas the second had reconstruction with freestyle propeller flap. The postoperative periods were uneventful, and timely adjuvant therapy was commenced. Limb function was preserved in the two patients. Conclusion: Treatment of soft-tissue sarcomas of the limbs could be tasking, but multispecialty surgical intervention and adequate adjuvant therapy could give favorable result and a functional limb postoperatively.